Barbora Paldus, Australia

University of Melbourne Department of Medicine St Vincent's Hospital

Presenter of 1 Presentation

A RANDOMIZED TRIAL OF CLOSED LOOP VERSUS STANDARD THERAPY IN GLYCEMIC MANAGEMENT DURING EXERCISE

Abstract

Background and Aims

Due to significant glycemic excursions, exercising with T1D can be challenging. Closed loop (CL) has been shown to improve glycemia in people with T1D.

The aim was to evaluate CL performance compared with standard therapy in people with T1D undertaking exercise.

Methods

Ten adults with T1D were randomly recruited from a large randomised controlled trial investigating CL versus standard therapy. Four participants were randomised to the standard therapy and 6 were randomised to CL. Participants undertook high-intensity-interval-exercise (HIIE) and moderate-intensity-exercise (MIE), 45-minutes duration, in random-order. Frequent venous samples measured glucose, ketones, lactate, free insulin, and counter-regulatory hormones. The primary outcome was CGM time-in-target range from beginning of exercise to 24 hours post exercise.

Results

Compared with standard therapy, CL resulted in improved time-in-range (66.5% vs 42%) and reduced time in hypoglycemia (11.3% vs 8.6%) for aerobic exercise and improved mean sensor glucose (9.8mmol/L vs 8.2mmol/L, p=0.0237) with no increase in hypoglycemia for anaerobic exercise.

Standard Therapy (n=5)

Hybrid Closed Loop (n=4)

p value

Aerobic Exercise

%time in 70-180mg/dL

42.3(16.7)

66.5(11.2)

0.0349*

Mean sensor glucose(mg/dL)

9.5(1.9)

8.6(0.7)

0.3474

Time<70mg/dL(%)1

11.3(14.1)

0(3.7)

0.0463*

Time<50mg/dL(%)

2.1(11.4)

0(0)

0.2444

Time>180mg/dL(%)

43.5(24.1)

31.9(10.6)

0.3631

Time>250mg/dL(%)

17.9(12.1)

6.7(5.1)

0.1017

Anaerobic Exercise

%time in 70-180mg/dL

61.2(29.9)

75.3(16.5)

0.0550

Mean sensor glucose(mg/dL)

9.8(1.5)

7.5(1.1)

0.0237*

Time<70mg/dL(%)

2.6(3.4)

5.1(4.9)

0.4064

Time<50mg/dL(%)

0(0)

0(2.0)

0.2235

Time>180mg/dL(%)

37.2(31.9)

14.8(8.2)

0.0550

Time>250mg/dL(%)

11.3(13.3)

0(2.0)

0.1724

Glucose metrics from beginning of exercise to 24hrs post exercise

mie_24hr_bg_ex.png

hie_24hr_bg_ex.png

Conclusions

Closed loop results in improved glycaemia compared with standard therapy during and after exercise without increase in hypoglycemia.

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